Gangrenous bowel in Nigerians

Abstract

Objective: This study is to critically examine gangrenous bowel as seen in a developing country to identify factors associated with mortality and to reappraise the problems in our environment. We also looked at mortality associated factors not considered by other studies from the subregion.

Design: We retrospectively reviewed the records of all patients who had gangrenous bowel over a 10 year period (1986 to 1995) at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Setting: University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Subjects: All patients with gangrenous bowel seen at the University of Ilorin Teaching Hospital, Ilorin Nigeria from January 1986 to December 1995 were included is this study.

Results: Ninety five patients were seen with a male to female ratio of 2:1. A high prevalence at age zero to five (17.9%) was noted due to childhood intussusception. The average duration of symptoms before surgery was 5.6 days. External hernia were responsible for 42.1%, intussusception for 22.1% and adhesions for 12.9% of cases. Other rarer and unusual causes of gangrene are also presented. Ileal gangrene was seen in 80.9% of cases. The overall mortality was 35.8% with no significant age and sex differences. Mortality varied directly with the length of gangrenous bowel irrespective of the cause and with the delay in operative intervention up to eight days. Peritonitis and involvement of the colon were also associated with high mortality.

Conclusion: As a result of late presentation allowing for high diagnostic accuracy, elaborate investigations to determine bowel viability have little role in our setting at present. Improvement in socio-economic status, health education, elective repair of hernia and early operative intervention are recommended to bring down the mortality from gangrenous bowel.